About Texas Children's Hospital
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org
for career opportunities. You can also learn more about our amazing culture at infinitepassion.org
We are searching for a Case Manager Road Warrior – someone who works well in a fast-paced setting. In this position, you will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs using a collaborative approach. You will provide comprehensive ongoing case management services to health plan members while coordinating and managing the care of high-risk members with multiple service needs across the continuum of care. You will ensure optimal member outcomes that address quality, service, customer satisfaction, and cost-effectiveness and assist the member/member's family in coping with illness by optimizing self-care abilities and supporting their consumer rights.
Think you’ve got what it takes?
- Proactively identifies members in need of case management through clinical rounds, medical management staff referrals, consultation with primary HMO staff, medical director, and PCP, parents, employees, home care staff, and other internal areas
- Communicates continually with members/families, medical staff, caregivers, and primary HMO staff to facilitate appropriate, timely, and cost-effective care
- Completes home visits and clinic or hospital visits with members as indicated
- Educates providers on network compliance, policies, and procedures of the organization’s Health Plan, managed care, and Medicaid
- Accurately accesses own learning needs and develops strategies to meet them
- Identifies and reports quality of care and quality of services issues and refers to appropriate Quality Management staff as evidenced in the Event Tracking system
- Provides community education/outreach for members when needed for health promotion for chronic disease management and health and wellness information
- Associate’s degree in nursing required or bachelor’s degree in nursing preferred
- RN – Licensed Registered Nurse from the Board of Nurse Examiners for the State of Texas
- DL ANY- Driver’s License for any state
- INSURANC- Auto Insurance for current automobile required
- CASE MGM- Case Management experience preferred
- 3 years of clinical experience in pediatrics including the following areas of expertise: home care, case management, managed care, or utilization review required
- Bilingual in Spanish and English preferred
- This position requires an Authorization to Release Personal Information must be signed before beginning work in this role
- Please note: As a remote worker/road warrior with the organization, this consent allows us to disclose an employee’s home address for the purposes of geomapping
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